This Aug. 28, 2017, file photo shows cigarettes displayed on a store shelf in New York. Indiana leaders are pushing for a hike in the smoking age to 21, for both traditional tobacco and vaping products.

In this Aug. 28 file photo, a man exhales while smoking an e-cigarette in Portland, Maine. A sharp rise in vaping, especially among youth, have given additional fuel to efforts to hike the legal smoking age in Indiana.

Efforts to hike smoking age to 21 gaining steam

This Aug. 28, 2017, file photo shows cigarettes displayed on a store shelf in New York. Indiana leaders are pushing for a hike in the smoking age to 21, for both traditional tobacco and vaping products.

AP

In this Aug. 28 file photo, a man exhales while smoking an e-cigarette in Portland, Maine. A sharp rise in vaping, especially among youth, have given additional fuel to efforts to hike the legal smoking age in Indiana.

You’ve got to be 21 to legally drink alcohol and, before long, you may also need to be 21 to buy tobacco products.

With the negative health effects of smoking well known for decades but a new rise in the popularity of vaping — especially among young people — a stronger consensus is growing to make a change that 18 states have already embraced.

Hiking the smoking age to 21 is an effort that’s been pushed for a few years now in Indiana, albeit unsuccessfully so far. But nationally, it’s a growing effort too, one that Indiana’s Sen. Todd Young has been aggressively stumping for.

Indiana is perennially one of the nation’s worst states when it comes to smoking. About 1-in-5 Hoosiers are smokers statewide, with similar rates in northeast Indiana.

According to the most recent data from the national health survey by the Robert Wood Johnson Foundation, Indiana’s smoking rate sits at 21%.

Noble and LaGrange counties have smoking rates of 21%, with 20% in Steuben County and 19% in DeKalb County, according to the survey’s data, accessible at countyhealthrankings.org.

Indiana’s smoking rate makes it among the 12 worst in the nation, according to the Centers for Disease Control. Neighboring Kentucky, West Virginia and Louisiana are the three worst — each with smoking rates between about 23-26.5% — but Indiana is in the next tier of states with rates between 19.5-23% smoking rates.

Most of those second-worst-tier states are located in the Midwest and South. Ohio, Missouri, Oklahoma, Arkansas, Tennessee, Alabama, Mississippi and Alaska — join the Hoosier state for the dubious distinction.

The goal of the Tobacco21 effort is pretty straightforward — raise the legal age to purchase tobacco products including cigarettes, cigars, chew and nicotine-containing e-liquids used for vaping, to 21.

Proponents of the plan cite two main positives of the idea.

First, it could help to reduce the smoking rate by keeping young people off tobacco products and nicotine-filled e-liquids for longer, thus reducing the likelihood they ever start or become lifelong smokers.

And second, any measure to reduce the prevalence of smoking will have a positive impact on health care costs to both businesses, which provide insurance to most adults as part of their job benefits, and to government, which picks up the tab for people on Medicaid or Medicare.

Young, a Republican senator in his first term, said he first took an interest in the Tobacco21 issue when his middle-school-aged daughter told him the school was canceling functions because students were vaping during these after-school events.

“She was in seventh grade at the time. The teachers and administrators indicated there were some kids who kept going into the bathroom and vaping,” Young said. “That made me attentive to how this is hitting home. These sorts of health risks were of incredible concern for me and I also heard from various roundtable conversation around the state that this is a priority.”

Young also spent one hourlong flight with Dr. Paul Haverson, the dead Indiana Univeristy’s school of public health in Indianapolis, and the two talked about preventative measures that could be taken to reduce smoking.

“He thought the most achievable and high-impact measure we could take is increase the age of purchase of tobacco products,” Young said. “I resolved at that point to take a stab at this, at the time unaware that this was a top priority of the Indiana Chamber (of Commerce) and had already been sort of socialized by them, and also unaware that this is an incredibly popular initiative among Hoosiers.”

As Young said, by the time he got on board with the idea and started promoting it at the federal level, the Indiana Chamber of Commerce had already laid some groundwork back home on various smoking-related issues.

Since the mid-2010s, the Raise it for Health Coalition has been advocating in Indiana for several measures including hiking cigarette taxes and restoring statewide tobacco prevention and cessation funding to $35 million.

That effort has received a major boost in recent years from the Indiana Chamber of Commerce, which has supported the efforts as a pro-business measure that would reduce health care costs and improve productivity of workers.

Indiana Chamber Executive Director Kevin Brinegar said hiking cigarette taxes and/or raising the smoking age to 21 could have major positive impacts on Indiana.

“Smoking costs Indiana employers $6.2 billion a year in higher health care costs, absenteeism and lost productivity,” Brinegar said. “That’s real money that isn’t going to wages and benefits and training and it’s disruptive for some workplaces when people are out sick because of smoking-related illnesses. We’re concerned. We’re also concerned that Indiana compared to other states is relatively unhealthy.”

One of the main goals of raising the smoking age is the hope that by forcing people to wait longer, they’ll either never start or, if they do, won’t become addicted for life.

According to Brinegar, 95% of people who end up becoming lifetime smokers started before age 18. The sharp rise in vaping has also been a major concern, since young people start out smoking nicotine-loaded e-liquids and get hooked.

While vaping was first presented as a way to help cigarette smokers transition away from the harmful smoke and potentially off tobacco altogether, what instead has happened is that nonsmokers have started to take up vaping and become smokers, Brinegar said. Studies have shown that teens who start vaping will often end up smoking cigarettes within 18 months of starting.

“The research shows there are considerably more people who go from vaping to smoking than from smoking to vaping,” Brinegar said. “We don’t know, we don’t have a long enough history to know what the effects of these vaping products are.”

But some of those effects are starting to show up. Recently people have been hospitalized with severe breathing issues due to vaping and a handful of vapers have also died.

More from this section

Eighteen states, including east and west neighbors Illinois and Ohio, have raised their smoking ages to 21. Brinegar acknowledges the jury is still out on whether the measure will have major impacts on reducing smoking — the first state to raise to 21 was Hawaii in January 2016 — but measures aimed at reducing access to tobacco generally do reduce smoking rates.

The data shows, for example, a strong correlation between higher cigarette taxes and lower smoking rates, Brinegar said. Smokers, especially young smokers who don’t have much disposable income, are price sensitive, so increasing the cost reduces the amount they consume.

Brinegar joked that there’s a saying around the Indiana Statehouse that good ideas take at least three years to pass, while bad ideas only take one, so the Chamber and its partners will continue to advocate these anti-smoking policies, he said.

In recent sessions, anti-smoking bills have had success in the House, but then stalled over on the Senate side. But with the sharp increases in youth vaping and more information coming out daily about the health impacts, Brinegar believes consensus is growing stronger every year.

“I sense given what’s happened with the vaping and the teenagers and high schools and counselors saying this is rampant in the high schools and even middle school, I think legislators are coming around,” Brinegar said.

Sen. Sue Glick, R-LaGrange, said lawmakers didn’t know much about vaping when the conversations first started happening. But that’s changed and Glick said she’s concerned by the rise in youth vaping, especially because e-liquids can be flavored so they smell and taste good as opposed to the tar and smoke of traditional cigarettes.

“I’m comfortable with putting an age limit on it,” Glick said this week. “What we want them to do is stop.”

Young, too, is confident that public opinion as well as lawmaker opinion about hiking the smoking age is rapidly turning. In the way that public health campaigns helped drive home the dangers of tobacco to Young’s generation, a new round of public education about vaping needs to happen.

“It’s essential that we would reverse current trendlines that could conceivable socialize smoking once again,” Young said. “Almost an 80% increase in tobacco utilization in high school students, and most of that driven by vaping, and almost a 50% increase in middle school.

“If that were to continue, it won’t be long until these pre-21 Americans will graduate into continued vaping and smoking the rest of their life,” Young said.

Although gridlock is the usual name of the game in Congress, Young was optimistic that an effort to hike the smoking age nationally could be approved even before the end of this year. Senate Majority Leader Sen. Mitch McConnell, R-Kentucky, introduced the Tobacco-Free Youth Act in May, although the bill hasn’t gone anywhere in the Senate yet.

Still, Young feels the outlook is positive.

“My expectation is that this will pass before the end of the year as part of a larger, highly bipartisan suite of healthcare cost reduction measures, and be signed by the president,” Young said.